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How to choose the best method for colon resection? The difference between open, laparoscopic or robotic surgery!
Colectomy is the surgical removal of sections of the colon, the longest section of the large intestine. Colectomy can be preventive, curative, or palliative, depending on the medical need. Common indications include cancer, infection, intestinal obstruction, intestinal rupture, and colon dysfunction. Colectomy can be performed open, laparoscopic, or robotically. After the surgery, the surgeon can restore intestinal connectivity or create a colostomy.
The way your colon is removed varies, depending on your condition, the skills of your medical team, and other factors.
Indications for Colon Resection
Common indications for colectomy include:
- Colorectal cancer
- Colon polyps that cannot be removed endoscopically
- Diverticulitis and other colon diseases
- Traumatic colon perforation
- Intestinal bleeding
- Chronic inflammatory bowel disease, such as ulcerative colitis or Crohn's disease
- Intestinal ischemia or intestinal infarction
- Intestinal torsion
- Intestinal stricture
- Chronic constipation
- Congenital intestinal diseases (such as Hilsprung's disease)
Surgical Procedures
Preoperative preparation
Before surgery, patients usually need blood tests and imaging tests, and may need a bowel preparation. For relatively non-urgent surgeries, doctors may recommend a clear liquid diet or fasting and mechanical bowel cleansing in preparation for surgery. In some cases, antibiotics may also be prescribed before surgery to reduce the risk of post-operative infection.
Surgical method
The traditional method of colon resection is through an incision in the abdomen, known as laparotomy. However, laparoscopic surgery has become a common surgical method in many medical institutions. Robotic-assisted colectomy is also growing rapidly and is being adopted by more and more physicians.
Laparoscopic Surgery
According to 2012 data, more than 40% of colon resections in the United States are performed laparoscopically. This procedure usually involves making 4 to 5 small incisions in the abdomen and using a cannula to enter the abdominal cavity so that a laparoscopic camera and other instruments can be placed.
Surgical Resection
Before removal, the part of the intestine to be removed needs to be dissected and tightened to cut off the blood vessels supplying it with blood. Surgical clamps are often used to prevent intestinal contents from leaking into the abdominal cavity. Surgery for colon cancer also often includes removal of lymph nodes to assist in staging the cancer.
Primary anastomosis vs colostomy
Once the resection is complete, the surgeon has the choice of rejoining the two ends of the intestine (primary anastomosis) or creating a colostomy. In emergency situations caused by trauma, the doctor may choose to preserve the segment during the first operation and repair it later.
Considerations when performing a colon anastomosis include the urgency of the procedure, the difficulty of the skill, and the patient's overall health.
Surgery risks
All surgeries involve risks, including bleeding, infection, and other complications. Risks after colectomy also include:
- Damage to surrounding tissues
- Re-surgery required
- Anastomotic leakage
- Risk of death
The choice of colectomy method must be determined based on the patient's specific circumstances, the physician's professional judgment, and surgical technique. In these choices, the patient's own ideas and needs are also indispensable factors. When choosing the right surgical method, have you considered all possible options and outcomes?
